Soft tissue oxygen saturation to predict admission from the emergency department: A prospective observational study

• Published in: The American journal of emergency medicine 2017-08, Vol.35 (8), p.1111-1117
• Main Authors: Davis, William T, Lospinso, Josh, Barnwell, Robert M, Hughes, John, Schauer, Steven G, Smith, Thomas B, April, Michael D
• Format: Article
• Language: English
• Subjects: Adult; Adults; Aged; Ambulatory care; Clinical decision making; Confidence intervals; Critical Illness - therapy; Data analysis; Decision making; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Epidemiology; Female; Health care; Hospital admission tests; Hospitalization - statistics & numerical data; Hospitals; Humans; Intensive care; Logistic Models; Male; Middle Aged; Near-infrared; Observational studies; Oximetry - methods; Oxygen; Oxygen Consumption; Oxygen content; Oxygen saturation; Patients; Pneumonia; Predictive Value of Tests; Prognosis; Prospective Studies; Regression analysis; ROC Curve; Sepsis; Severity of Illness Index; Soft tissue oximetry; Spectroscopy; Spectroscopy, Near-Infrared; Spectrum analysis; Triage; Triage - methods; United States; Variables
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.03.013

Abstract Objective We evaluated a soft tissue oxygen saturation (Sto2) measurement at triage for predicting admission to the hospital in adults presenting to the emergency department (ED) in addition to data routinely gathered at triage. Methods This was a prospective, observational, single center study of adults presenting to the ED for evaluation. Research assistants obtained thenar eminence Sto2 measurements on patients in ED triage. ED providers not involved in the study then made all management and disposition decisions. We prospectively collected data on each subject's final ED disposition (admission versus discharge). We identified the optimal Sto2 cutoff value for predicting admission. We then used logistic regression modeling to describe the added predictive value of Sto2 beyond routinely collected triage data including Emergency Severity Index level, age, and vital signs. Results We analyzed 2588 adult (> 17 years) subjects with 743 subjects (28.7%) admitted to the hospital. Sto2 < 76% was the optimal diagnostic cutoff for predicting admission. Of subjects with Sto2 < 76%, 158 of 384 (41.1%) underwent admission versus 585 of 2204 (26.5%) subjects with Sto2 ≥ 76. After controlling for age, vital signs, and ESI level in the logistic regression analysis, Sto2 < 76% had an odds ratio of 1.54 (95% confidence interval (CI), 1.19 to 1.98) for predicting admission. Conclusions Sto2 may provide additional prognostic data to routine triage assessment regarding the disposition for undifferentiated adult patients presenting to the ED.